Effects of treatment with etanercept versus methotrexate on sleep quality, fatigue and selected immune parameters in patients with active rheumatoid arthritis

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Effects of treatment with etanercept versus methotrexate on sleep quality, fatigue and selected immune parameters in patients with active rheumatoid arthritis
Key Take-Away: 

Etanercept (ETA) is a biopharmaceutical tumor necrosis factor (TNF) inhibitor that curbs autoimmune diseases by interfering with tumor necrosis factor. Methotrexate (MTX) is employed when some kind of 'over-activity' in the body is causing problems. Efficacy of ETA and MTX is deduced appropriately in this study for many variables in the active rheumatoid arthritis patients.

Etanercept (ETA) is a biopharmaceutical tumor necrosis factor (TNF) inhibitor that curbs autoimmune diseases by interfering with tumor necrosis factor. 

ABSTRACT: 
Background: 

To compare sleep quality, disease activity and patient-reported outcomes such as fatigue and immune parameters in patients with rheumatoid arthritis treated with etanercept (ETA) or methotrexate (MTX).

Methods: 

Of 36 patients (28-joint Disease Activity Score, DAS28CRP≥3.2) in this 16-week (w), open, prospective study, 19 (11 women) received MTX 12.5–17 mg/w, and 17 (14 women) received ETA 25 mg x 2/w, alone or in combination with MTX.

Clinical (DAS28CRP, visual analogue scale), laboratory (C-reactive protein [CRP]), sleep (polysomnography), functional (Multidimensional Fatigue Inventory; Health Assessment Questionnaire-Disability Index (HAQ-DI); 36-item Short-Form Health Survey (SF-36), immunological (humoral/cellular) and neuroendocrine (hormonal) parameters were recorded at baseline (BL), w8 and w16.

Results: 

BL characteristics did not differ significantly between the ETA and MTX groups except disease duration: mean age (years): 48.6±8.8 vs. 49.4±16.6; mean disease duration (months): 19.6±46.3 vs. 81.2±79.2; and DAS28CRP: 4.4±0.9 vs. 4.4±1.7, respectively.

DAS28CRP, SF-36, and HAQ-DI improved significantly in both groups from BL to w16 (p≤0.05). The DAS28CRP improvements at w16 (mean changes -1.8 in the ETA group, and -1.4 in MTX group), were not statistically significant from each other. The absolute values of sleep efficiency, total sleep time, and stage 2 sleep duration increased significantly in the ETA group, but no significant changes were reported in the MTX group.

Conclusion: 

Both therapies improved disease activity, CRP, SF-36 and HAQ-DI, with faster, more pronounced changes in DAS28CRP in the ETA group, which alone had significantly improved sleep parameters.

Clinical and Experimental Rheumatology 2016; 34 (5): 0848:0856
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